Animal's Weight (In pounds)*
Where or how was the animal originally acquired?*
Is the animal housetrained?*
Is the animal spay/neutered?*
Date of last Rabies Vaccination
Date of last Distemper vaccination
Date of last Bordetella (kennel cough) vaccination
Date of last heartworm test
Results of last heartworm test
Is the animal currently on heartworm preventative?
Date that heartworm preventative was last given
Is the animal currently on flea/tick preventative?
Date the animal was last given flea/tick preventative
What brand food and amount does the animal eat each day?
Is the animal used to a fenced in yard? Tie out? Other?
Where does the animal sleep?
Where is the animal when you are away from home?
Is the animal used to being in a kennel or crate? For how long?
How does the animal react to small children? (detailed answer)
Hows does the animal react to older children, men and/or women? (detailed answer)
What is the animal afraid of? (detailed answer)
Reaction to new people
Hows does the animal react to dogs? (detailed answer)*
How does the animal react to cats?*
Does the animal have a bite history?*
If the animal has a bite history, describe the incident(s), the person(s) or other animal bit, number of incidents, etc (detailed answer)
Reason for surrendering animal (detailed answer)*